Rutgers study shows decreased hospitalizations for diabetes patients associated with telementoring program

The use of Project Extension for Community Healthcare Outcomes (ECHO), an endocrinology telementoring program at Rutgers Robert Wood Johnson Medical School (RWJMS), has been associated with a decrease in hospitalizations for Medicaid patients with diabetes, according to a recent press release.

Mary Bridgeman, a clinical professor at the Ernest Mario School of Pharmacy and the co-lead of Project ECHO, said that the model started with the desire to improve access to treatment for Hepatitis C with a knowledge-sharing network and virtual clinic.

“Project ECHO is a technology-driven guided practice model that exponentially increases health care workforce capacity to provide best-practice specialty care and reduce health disparities,” she said.

A typical session will consist of a topic presentation led by a specialist followed by a group discussion, Bridgeman said. This way, community providers can receive input from many other health care professionals to improve the quality of patient care.

She added that Rutgers has been using this model since 2017 and has collaborated with a team of pharmacists, nurses, social workers and physicians in order to provide care to individuals with complex endocrinological needs.

Louis Amorosa, an endocrinologist at RWJMS and another co-lead of Project ECHO, said that the project was initially started at the University of New Mexico and was expanded nationally due to its utility for both physicians and patients.

University researchers investigated whether ECHO was changing patient outcomes and found that doctors who participated in the program had patients with fewer hospital admissions and emergency room visits, Amorosa said.

The model for Project ECHO is based on the “all teach, all learn” model, which encourages participants to engage in thoughtful discussions, unlike traditional medical education, Bridgeman said. This ensures that local community providers have the necessary knowledge to properly conduct procedures, she said.

Joel Cantor, director of the Center for State Health Policy at the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the study, said that researchers analyzed data from New Jersey’s Medicaid program, which provides coverage for approximately 2 million low-income individuals.

The team used provider and patient characteristics to compare patient statistics and trends of primary care providers in Project ECHO to those not in the program, he said.

Cantor said that the team found that the utilization of and spending on hospital services was lower for patients of primary care providers that participated in Project ECHO relative to those who were not in the project.

Though, he said more research is needed in order to determine the specific circumstances in which Project ECHO can lead to better patient care.

Cantor said that the telementoring concept in relation to the project is particularly interesting because the relevant technology has been around for a while but became more prevalent due to the pandemic.

“We are all familiar with Zoom meetings these days, but Project ECHO has used that technology for many years to gather healthcare providers to hear from experts and learn from each other,” he said. “It uses everyone’s time efficiently and may be an effective tool for helping providers improve quality of care.”

Bridgeman also said that the pandemic necessitated the quick mobilization of expert knowledge, which was made possible with the project.

She said a functional Project ECHO model facilitated the change to virtual systems and also assisted in connecting experts with frontline health care workers and professionals to better inform physician practices.

Bridgeman said that she is hopeful for the future of Project ECHO, especially since 93 percent of countries have been influenced in some way by the model since the project’s inception nearly 20 years ago. 

“I am always surprised when I encounter a provider who hasn't yet heard of Project ECHO, and I always encourage them to seek out more information — it is undeniable ECHO has and will continue to revolutionize the way we think about patient care,” she said.